A Prospective Case Series Evaluating Complications and Patient Experience of Flexible Nasendoscopy

Flexible nasendoscopy (FNE) is a commonly undertaken procedure in Otolaryngology, enabling a dynamic evaluation of the structure and function of the upper aerodigestive tract. Despite FNE being performed routinely in clinical practice, studies investigating the associated complications are lacking. The aim of this prospective case series is to evaluate patient experience and complications associated with FNE.

This prospective consecutive case series evaluates the experience of 143 patients undergoing assessment for laryngeal pathology. A questionnaire was given to 181 consecutive patients prior to their outpatient appointment. The forms offered the patients the opportunity to evaluate apprehension prior to FNE, perceived pain during FNE, and decisional regret following FNE, by means of visual analog scale scores. Patient-reported complications were categorized into eight domains and collected prospectively. Responses were collected and the data analyzed using GraphPad Prism Version 10.4.1 (532).

Out of 181 patients, 143 (79%) answered the questionnaire. Mean apprehension score was 24.8%, mean pain score 18% and mean decisional regret score 3.7%. Eighty-eight patients (62%) experienced no complications associated with FNE. Fifty-five patients experienced between 1 and 4 complications each. Forty patients (28%) experienced gag reflex activation, 24 patients (16.8%) experienced cough, and 10 (7%) reported sore throat as a result of FNE. One patient experienced epistaxis, and no patients had vasovagal syncope. Ten patients (7%) required a topical anaesthetic to tolerate the procedure, 2 patients (1.4%) required alternative examination with a rigid nasendoscope, and for 1 patient, the procedure was abandoned due to equipment malfunction.

FNE is a safe, commonly performed procedure. The rate of individual complications in this prospective case series is low. This study's findings have the potential to enhance the process of informed consent by enabling clinicians to refine their practice in offering a clearer understanding of the incidence of common complications of FNE.

Uncontrolled prospective case series of consecutive patients: Level IV.